You can read my substantive tribute to AMHPs who go AMHPing from my 2017 post which attempts to explain their role from an outsiders point of view. Whenever I mention Approved Mental Health Professionals (AMHPs) for the first time in a new blog post, I give that link so people can read about the role behind the acronym if they want more information. Of course, there is much more to their role than any police officer would regularly see. Officers normally see AMHPs after use of s136 of the Mental Health Act (MHA) or during statutory assessments in police custody. Less often, they may meet AMHPs at MHA assessments in the community, perhaps where a s135(1) warrant is being waved but perhaps not but they will rarely see anything of AMHPs authorising Community Treatment Orders, or conducting MHA assessments in hospitals three hundreds miles away from where they normally work. They see nothing of AMHPs in mental health tribunals or attempting to work out who on earth is someone’s Nearest Relative.
29th June 2024 is National AMHP Day and the AMHPs in our lives deserves another post – the AMHPs in my life include old friends who became AMHPs and AMHPs who became new friends as well as online AMHP contacts I’ve never met, but with whom I regularly chat via social media or email. I repeat a point I’ve made many times: it’s the most thankless job in the mental health system as far as I can tell – and that’s up against stiff competition in fairness to the other professional groups. Far too many people don’t know what an AMHP is and even courts and people who should know better get the acronym wrong. We even see this in official court documents like judgments or Preventing Future Death notices. ‘Accredited’ is less often seen than ‘Practitioner’ and it’s rare you seem them both present together, but “Accredited Mental Health Practitioners” are not unheard of despite not being a thing.
Two things I love to repeat about AMHPs who go AMHPing –
- It is a criminal offence to obstruct an AMHP in the course of their duty (section 129 MHA)
- AMHPs are NOT responsible for finding beds when someone needs to be ‘sectioned’ – that’s the doctor’s job.
RING-MASTERING THE CIRCUS
AMHPs have the most difficult job, as far as I can tell – they have all the responsibility for making sure certain things are done and absolutely none of the authority to command the resources which are necessary to ensuring it is. As such, they deserve the love and respect of us all for daring to do the role at all, underpaid as it undoubtedly is as well – easily worth double the money or more. They are the warrant card carrying legal officers of the mental health system, they are the ones who take away your liberty and have to think very carefully about how to balance your fundamental human rights whilst considering doing so. No-one reading this will be unaware of the examples which abound of where particular AMHPs haven’t been able to strike that balance but in fairness to them – they cannot make the NHS magic up a female PICU bed placement with zero notice just because one is needed. But if you read AMHP social media and discussion groups, you see legal eagles and philosophers within – and we need that.
What may have come as a nasty shock to many AMHPs recently were a judge’s remarks in a recent out-of-hours application to the High Court from Surrey Police. You can read the fuller post on that ruling at your leisure, but for here it concerned someone rotting away in police custody for days because the NHS could not offer up a bed for their admission. The police took this to the High Court and it ended with the Local Authority being required to cover the Official Solicitor’s costs because of a view the particular AMHP involved should have been more pro-active in challenging or ensuring the legal basis for the man’s detention pending a bed being found. The point being made was the patient’s Article 5 rights (to liberty) were directly threatened by the situation and AMHPs (as well as others) have duties to protect those rights once engaged. Some may have a view the inplications if there being no bed should be pointed towards those who should be providing beds, but that perspective probably helps you understand why I’m not a judge.
Now! … I’m told this case is already the stuff of discussion at AMHP training days and it’s certainly all over their social media. AMHPs find themselves in this kind of situation in excess of 4,500 times a year where people require ‘diversion’ from police custody after arrest. My own estimates cause me to think they find it occurring in section 136 Place of Safety suites another 5,000-5,500 thousand times a year. I don’t know whether we have enough High Court capacity for 10,000 applications a year but I do know something else:
WORKFORCE PROBLEMS
We don’t have enough AMHPs for them to be involved in the post-assessment minutiae of NHS struggles to identify beds. Perhaps it would help if areas had properly formatted, well-considered joint protocols on the operation of section 140 MHA, as required by paragraph 14.80 of the Code of Practice MHA? Of course, that would also mean they needed more beds to manage demand and that’s against the direction of travel for the last seventy years, no matter how many lives end up lost (and estimates of that are in the tens of thousands).
Our AMHPs are under more pressure than ever before and guess what: we have a recruitment and retention crisis. The AMHP work-force is older than ever, younger social workers are not coming forward to seek out the role as much as before and this may explain why, for example, large cities in England and Wales have no AMHP on duty overnight, notwithstanding the duty in the Code of Practice for local authorities to ensure sufficient AMHP coverage and notwithstanding that AMHPs are the only professionals in the public sector who can trigger use of certain legal powers.
So the practice of AMHPing is increasingly an art for those who are courageous enough to wrestle with its rigours – the art of spinning plates, of doing less with more; the art of being answerable to everyone and yet to no-one but the law. AMHPs are independently attested, as police officers are, and ultimately, they are answerable to the law alone for their practice. It’s therefore such a shame they are require to stand in the centre of the circus where it is all too often a law free zone.
Happy AMHP Day, to those engaged in the Art of AMHPing — and thank you sincerely for what you do for us.
Winner of the President’s Medal, the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award
All opinions expressed are my own – they do not represent the views of any organisation. (c) Michael Brown, 2024
I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current. Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.
Government legislation website – www.legislation.gov.uk
Mental Health Cop 